This blog is totally independent and has only three major objectives.
The first is to inform readers of news and happenings in the e-Health domain, both here in Australia and world-wide.
The second is to provide commentary on e-Health in Australia and to foster improvement where I can.
The third is to encourage discussion of the matters raised in the blog so hopefully readers can get a balanced view of what is really happening and what successes are being achieved.

Saturday, July 05, 2014

Weekly Overseas Health IT Links -5th July, 2014.

Note: Each link is followed by a title and few paragraphs. For the full article click on the link above title of the article. Note also that full access to some links may require site registration or subscription payment.

Merely making health records digital won't fulfill the promise of health IT to improve care and cut costs, according to a new issue brief from data analytics company Health Fidelity. It urges healthcare organizations to move beyond merely meeting federal mandates--or risk being left behind.

While the $19.2 billion Meaningful Use Incentive Program encouraging adoption of electronic health records has shown success, those systems merely capture and store data, the paper points out.

The majority of hospitals still do not engage in the electronic exchange of health information, despite strong federal policies designed to encourage these exchanges and a substantial investment in health information technology.

That is the finding of a study by researchers from the University of Michigan and Harvard University. The study, written by Julia Adler-Milstein from the University of Michigan and Ashish K. Jha, of Harvard, sought to assess whether current policy efforts--many of which are being developed by states--appear to be tackling the key barriers to hospital participation in health information exchange.

Joy Pritts: Health IT security is a constantly moving target

June 27, 2014 | By Katie Dvorak

The biggest challenge for the next chief privacy officer at the Office of the National Coordinator for Health IT will be keeping up with emerging ways of sharing information, and looking at them from a privacy and security perspective, Joy Pritts, the office's outgoing privacy chief, said.

Pritts' announced departure came in the wake of a shakeup at the ONC. Late last month, the agency revealed plans to reorganize, cutting the number of offices within the agency--though Pritts' position was not among them.

The biggest challenge for the next chief privacy officer at the Office of the National Coordinator for Health IT will be keeping up with emerging ways of sharing information, and looking at them from a privacy and security perspective, Joy Pritts, the office's outgoing privacy chief, said.

Pritts' announced departure came in the wake of a shakeup at the ONC. Late last month, the agency revealed plans to reorganize, cutting the number of offices within the agency--though Pritts' position was not among them.

Healthcare organizations continue to work to integrate clinical decision support systems into clinical workflow, and to overcome distaste for what many refer to as "cookbook medicine," according to physician technologist Joseph Kim.

While some systems are integrated seamlessly into electronic health records, others produce an array of alerts and wind up being useless because providers ignore them, Kim pointed out in a recent post to SearchHealthIT.

Through a recently launched $11 million initiative--"Accelerating Change in Medical Education"--the American Medical Association aims to develop innovative ways to educate physicians who feel more comfortable using tech tools such as CDS at the point of care, according to Kim. They also will be able to better advise vendors on how to improve those tools.

Three million patients around the world were using connected home medical monitoring devices in late 2013, but this number will jump to 19.1 million by 2018, according to a report from research firm Berg Insight. Remote patient monitoring revenues reached $5.8 billion (4.3 billion euros) in 2013 and are expected to grow to $26.4 billion (19.4 billion euros) by 2018.

Around 76 percent of these revenues came from connected medical devices. For the report, Berg only looked at patients who used home monitoring devices to collaborate with a professional caregiver. The research firm did not include patients that used the devices for personal health tracking.

The most widely used connected medical device category in 2013 was cardiac rhythm management (CRM) devices. According to Berg’s estimates, CRM devices accounted for two-thirds of all connected monitoring devices. After CRM devices, sleep therapy and telehealth were the next largest device groups.

EHRs are commonly promoted as boosting patient safety, but are we all being fooled? InformationWeek Radio investigates.

One of the top stated goals of the federal Meaningful Use program encouraging adoption of electronic health records (EHR) technology is to improve patient safety. But is there really a cause-and-effect relationship between digitizing health records and reducing medical errors? Poorly implemented health information technology can also introduce new errors, whether from scrambled data or confusing user interfaces, sometimes causing harm to flesh-and-blood patients.

This is the issue we will tackle in our InformationWeek Radio show, Is Digitizing Healthcare Making It Less Safe?, Tuesday, July 1, at 2 p.m. EST. My guest for the show will be Scot M. Silverstein, M.D., a consultant and professor in the Drexel University informatics program who researches the shortcomings of EHR software. He also tracks the literature on EHR risks and offers his interpretations on the Health Care Renewal blog, where he posts as InformaticsMD. Silverstein serves as an expert witness in cases involving malfunctioning EHRs or malpractice cases involving the reliability of evidence recorded in EHR systems.

Personal computers remain the tool of choice for electronic health record users, despite the rise in tablets and smartphones, according to the latest report from Epocrates, an athenahealth company.

The company's third annual mobile trends report surveyed 1,257 healthcare providers, including physicians, pharmacists, nurse practitioners and physician assistants from its market research panel in May. It found that 41 percent of clinicians were "digital omnivores," using computers, tablets and smartphones to access their EHRs. However, that's a "far cry" from the 82 percent of digital omnivores predicted last year and down from 47 percent of self-reported omnivores in 2013.

"Necessary IT upgrades, software training, and workflow modifications throughout a practice may also divert clinicians' time and attention away from other resources, and undermine their appetite to integrate yet another gadget into their daily routine," the report's authors said.

Providers have been lashing out against subpar electronic health record design for years. They gripe that not only do poorly designed systems impede workflow and cost too much, they also create new patient safety problems and don't share data with other systems to coordinate care, as promised. Still, the industry hasn't done much to address these concerns.

However, maybe now they'll have to. New evidence released this week bolsters what the providers have been saying all along: EHRs, as currently designed, adversely impact patient safety.

First, there's the new study of adverse patient safety events at the Veterans Affairs Department (VA), which operates a voluntary, non-punitive reporting program of such incidents. Three-fourths of the 100 EHR-patient safety issues studied related to design issues. Moreover, a whopping 94 percent of the safety concerns were traced back to just four problems, all of them design flaws, including:

Unmet data display needs, such as small print or a "poor fit" between information needs and the clinician's task on hand

Problems with software upgrades and modifications, which created configuration errors

System-to-system interface problems

"Hidden dependencies" within the EHR, such as use of matching algorithms that created errors and delays.

Apple has been making headlines again, which is not unusual for a company that sets trends and moves markets. A week or so ago they announced that iOS 8 would have a built-in app to collect all of your health info in one place. Then there was the announcement of the partnership with Mayo Clinic and Epic Systems. This generated even more headlines. I saw all kinds of opinion pieces published, ranging from predictions that this will be the ‘game changer’ that mHealth has been waiting for, to those who said, “Not so fast. What is really novel here?” I let the dust settle, processed all of this, and came up with the following reflections.

It’s impossible to give an educated opinion because all we’ve seen so far are some hints at what the software will do. We have no idea what the hardware play will be and we don’t yet know all of the planned software capabilities. However, there are some things I believe we can count on.

With sights set on spurring healthcare innovation and interoperability, Royal Philips has teamed up with customer relationship management company salesforce.com to bring a new open, cloud-based platform to the market.

The Privacy and Security Tiger Team will tackle data security and privacy complexities involving minors' electronic records at its next meeting on July 14, reportsHealthcareInfoSecurity.

One of the problems involves laws that vary from state to state allowing minors to obtain certain health services--such as reproductive health services or substance-abuse treatment--without the consent of parents. Disclosing such information to parents could be a HIPAA violation, privacy attorney Adam Greene, a partner at law firm Davis Wright Tremaine, pointed out previously.

Healthcare facilities are constantly in danger of being hacked and having data stolen, but two researchers have found that many hospitals themselves leak valuable information online.

The data leaks result from network administrators enabling Server Message Block, or SMB, which, when configured a certain way, broadcasts the data externally, researchers Scott Erven, head of information security for Essentia Health, and Shawn Merdinger, an independent healthcare security researcher and consultant, shared in a recent Wiredarticle.

SMB is a protocol used by administrators to quickly identify, locate and communicate with computers and equipment connected to an internal network, according to the article. Erven and Merdinger found that hospitals misconfigure the SMB service, which allows outsiders to see it.

The British Medical Association has voted in favour of making care.data an opt-in system rather than an opt-out one.

After a short but passionate debate at its annual representative meeting this morning, a motion criticising many aspects of NHS England’s flagship big data initiative for healthcare was carried, including the requirement for patients to opt-in.

Care.data aims to expand the Hospital Episode Statistics and to link them to other data sets, starting with GP data. This information will be released to researchers and others.

However, the programme has been delayed until at least the autumn, following a public outcry about the consent model and concerns about exactly who will be able to receive information. A publicity campaign this spring was criticised for its lack of clarity and for failing to include an opt-out form.

The developers of a new mobile testing kit for "tracking health information at the molecular level" might be marketing this to consumers, but devices such as this have strong value for providers as well.

Cue, a San Diego-based startup, unveiled its product of the same name this past May. The 3-inch tall device takes a drop of saliva and analyzes it for five molecules: C-reactive protein (CRP) a marker for inflammation in response to stimulus like injury or chronic illness; Vitamin D; Luteinizing Hormone (LH), a marker for fertility; Influenza; and Testosterone. The tests take a few minutes, with results sent to the user's smartphone.

Ayub Khattak, Cue's co-founder and CEO, and Clint Sever, the company's co-founder and chief product officer, say the device gives consumers an opportunity to track vital lifestyle information whenever and wherever they want. Just as important, they say, it gives them information to use in communications with their doctors, resulting in a much more enriched and useful conversation.

The Certification Commission for Health Information Technology (CCHIT) has launched a new service that provides direct counsel to health IT developers on how to best satisfy health IT regulations published by the Office of the National Coordinator for Health IT (ONC).

Available now are The Guide--CCHIT’s online, subscription-based ONC testing and certification preparation service--and a menu of six individually tailored programs covering basic orientation, clinical quality measures, interoperability and preparing for successful testing of all criteria including those for Base or Complete EHRs, according to a release.

Independent report lays out a robust path to interoperability. Will we follow it?

The Agency for Healthcare Research and Quality (AHRQ) recently posted "A Robust Health Data Infrastructure," a report from JASON, an independent group of scientists that since 1960 has advised the US government on science and technology.

For those of us who are concerned about interoperability and worry that the Meaningful Use and EHR software certification bars may have been set too low, this report presents a potentially exciting glimpse of the future -- if the recommendations survive and actually get implemented. I'll come back to that point after reviewing some of the key recommendations.

I am pleased that this report is consistent with our intent to support nationwide interoperability in a way that supports care, health and is flexible enough to meet the challenges of the future. The ONC and the Centers for Medicare & Medicare Services (CMS) have already begun to work on many of the recommendations cited in the report -- this represents the beginning, not the end of our efforts. The JASON recommendations continue to challenge us to stay focused on the path ahead.

That's the advice of IT security experts who have been through the process: Michael Boyd, chief information security officer for Providence Health & Services, a Seattle-based system with 32 hospital and more than 550 other sites; and Clark Kegley, assistant vice president of information services for the Scripps Health, a San Diego-based four-hospital system.

Speaking at the HIMSS Media Privacy and Security Forum last week in San Diego, Boyd said hospital executives charged with crafting a policy for mobile devices need to approach this not as a security concern, but as a new means of bringing technology into the workplace. In other words, work with the clinicians who are using their own devices, instead of against them.

The following technologies all address care transitions in different ways. But all have one thing in common: They have the potential to make patients feel more connected to their care and clinicians more connected to their patients, especially during care transitions.

1. Mobile-location based services

From simple wayfinding to more complex patient flow applications, GPS and other mobile-location devices and services are keeping tabs on patients at every point of care. At any given time, hospital staff can see where a patient is in the hospital, avoiding duplicate tests or sending someone to the wrong room.

The government’s health technology funds have invigorated the nursing observations and vital signs markets – and brought in new entrants. Fiona Barr looks at the options, talks to trusts about the benefits, and collects tips for organisations that want to move in the same direction.

The availability of central funding for IT to support bedside observations is proving a tempting offer.

A total of 21 trusts successfully bid for money from the first round of the Nursing Technology Fund before it gave out £30m in April; and suppliers are predicting that more trusts will submit bids in the £70m second round, due to launch next month.

The £260m ‘Safer Hospitals, Safer Wards: Technology Fund’, now renamed the ‘Integrated Digital Care Fund’, which runs to March 2015 is also providing funding for vital signs systems, although it requires trust to provide matched funding for their projects.

A pilot program for the Food and Drug Administration’s Sentinel active surveillance system, dubbed Mini-Sentinel, is leveraging electronic healthcare data--principally claims data but also including data from EHRs--to monitor the safety of FDA-regulated medical products.

According to Janet Woodcock, M.D., director of the FDA’s Center for Drug Evaluation and Research, the Mini-Sentinel system can survey more than 350 million person years of observation, 4 billion pharmaceutical dispensings, and 4.1 billion patient encounters.

“Thanks to the ability to access data from various sources, the Mini-Sentinel system can use the information from potentially more than 150 million covered lives in our nation’s health care system to help answer important drug safety questions,” writes Woodcock in a June 23 blog.

The Internet is increasingly redefining the ways in which people interact with information related to their health. The Pew Internet Project estimates that more than half of all Americans sought health information online in 2013, mostly through search engines such as Google and websites such as Wikipedia and WebMD.

In this digital age, engaging with new media offers an unparalleled opportunity for medical and public health professionals to find information they need and to interactively reach out to patients and their support networks. One domain where these capabilities may have far-reaching effects that are currently undefined is drug safety. As the volume of health-related information on the Internet has grown, important questions have emerged. How are messages from regulators — for example, warnings against using a drug in a specific patient population — diffused digitally? And are the messages still accurate when they reach the general population?

Call it Big Data bloodlust: The more health information being generated by a growing contingency of apps, devices, electronic health records, mHealth sensors and wearables, the broader and stronger the desire for that data becomes.

And those are just sources of health information. What about data not traditionally considered part of healthcare that could be used either for or against a patient?

In numerous other industries, buying habits are already widely tracked by many social media sites and used for advertising. Though some have complained this is an intrusion, nothing much has been done to prevent this type of surveillance, so far.

NHS trusts that fail to make proper use of electronic health records should be hit with higher insurance premiums and a reduced Care Quality Commission rating, according to a new report.

The Sowerby Commission report also says that patients should be given a legal right of access to interact with and share their electronic record and new rights of redress if their data is misused.

The commission, a group of experts established by the Institute of Global Health Innovation at Imperial College London, undertook a year-long investigation to assess the benefits and risks of sharing electronic health records

Uncertainty about where sensitive and confidential data is located causes more worry for security pros than hackers or malicious employees, according to a new survey from the Ponemon Institute.

The report, based on a poll of 1,587 IT security practitioners in 16 countries, focuses on the state of data-centric security, which it describes as a security policy that follows data wherever it is replicated, copied or integrated.

Putting healthcare information in the hands of patients and giving them a voice in their own care was the theme that threaded its way through the 21st Century Cures panel discussion Tuesday morning.

The House Energy and Commerce Committee headed the panel, with Rep. Fred Upton (R-Mich.) moderating, which covered what steps Congress can take to bridge the gap between advances in healthcare technology and the regulatory policies that govern them. The committee released a white paper on the initiative last week.

Panelists included industry experts, doctors and CEOs--all of whom touted the importance of consumer control over their own healthcare information.

The VA might be struggling to find its way out of very hot water when it comes to its scheduling services, but there’s more to the healthcare system than the mushrooming scandal. The VA has long been a leader in the telemedicine arena, and a new study published by Adam Darkins, Chief Consultant for Telehealth Services, highlights some very positive results from the suite of programs and pilots. Eleven percent of veterans received some portion of their care remotely in 2013, with the number of patients accessing telehealth through the VA growing approximately 22% annually, Darkins says. Remote programs have contributed to a 35% reduction in hospital admissions among home telehealth patients and a 59% reduction in bed days of care throughout 2013.

In the past year, the VA’s telehealth services have provided nearly 1.8 million episodes of care to over 608,000 patients. Forty-five percent of those patients lived in rural areas with limited access to physical facilities, and may not have received adequate care without clinical video services, mHealth, and home health services to support self-management for depression, PTSD, and other chronic conditions. Of the 144,520 patients enrolled in home telehealth services, 41,430 are living independently in their own homes instead of relying on long-term institutional care.

by George Lauer, iHealthBeat Contributing Editor Tuesday, June 24, 2014

A partnership of private organizations and public agencies launched a pilot project last week in Ventura County, Calif., aimed at improving social and health care coordination for children in foster care.

Spurred by federal initiatives supporting expanded use of health IT, the project -- called Ventura County Foster Health Link -- is designed to be used as a model for other communities in California and the nation. The program allows caregivers, social workers, guardians and the kids themselves the ability to communicate and share information over the Internet.

Eventually, the policies and practices being tested in Ventura County could be applied to all children, officials said.

Cora Nucci, for HealthLeaders Media , June 24, 2014

Payment reform based on knowledge gleaned from business intelligence and data analytics tools in hospitals and health systems is no longer optional. It's imperative. If you're not up to the task, start lobbying for additional resources now.

Healthcare finance executives are like the knife thrower's assistant who stands rigid while gleaming blades flicker past her head one after the other: declining Medicare reimbursements—phhhffft—falling inpatient volumes—phhhffft—rising expenses—phhhffft.

The Food and Drug Administration has issued draft guidance informing industry that the agency does not intend to enforce compliance with the regulatory controls that apply to medical device data systems, medical image storage devices, and medical image communications devices, due to the low risk they pose to patients.

“In 2011, FDA issued a regulation down-classifying medical device data systems. Since that time, FDA has gained additional experience with these types of technologies, and has determined that these devices pose a low risk to the public,” writes Bakul Patel, senior policy advisor in FDA’s Center for Devices and Radiological Health, in a June 20 blog.

It's too easy for hospitals--especially small facilities with little IT expertise--to rely too heavily on vendor experts to help them get their new technology up and running. And that can end badly, as 25-bed Girard Medical Center in Kansas illustrated in its dispute with Cerner.

To that end, Michael Dagley, an attorney with Nashville-based Bass, Berry & Simsan who specializes in software disputes, offers advice on protecting your hospital in disputes with vendors when the technology doesn't perform as promised, in a recent Becker's Hospital CIO post.

When it comes to disclosing private information, patients apparently would rather open up to "virtual humans" than their real-life, medically licensed counterparts.

Researchers found that people who believed they were interacting with a computer were more willing to disclose information and respond to questions honestly, according to a new study published in Computers in Human Behavior. Participants of the study also were likely to display their sadness "more intensely" and had a "lower fear of disclosure," than other patients.

Half of the 239 participants were told their conversation was computer-driven and not observed, according to a Pacific Standardarticle. The others were told they were being watched by a person in another room who was using a computer to ask the questions. In all cases, video images of the participants were recorded to gauge their level of emotional expression.

A new report from Flurry Analytics shows that health and fitness apps are growing at a faster rate than the overall app market so far in 2014. The analytics firm looked at data from more than 6,800 apps in the category on the iPhone and iPad and found that usage (measured in sessions) is up 62% in the last six months compared to 33% growth for the entire market, an 87% faster pace.

This data comes just as Apple and Google aim to boost the ecosystem for fitness apps and wearables with HealthKit and Google Fit, both of which aim to make it easy for wearable device manufacturers to share their data and app developers to use that data to make even better apps.

Electronic health records (EHRs) are simply a 21st Century version of the paper charts formerly used by your doctor to record your medical history, notes, and other information about your health, including medications, lab results, past diagnoses, vital signs, immunizations, and test reports. Although many physicians have already adopted EHRs, soon all practices and providers will be required to use them so it is important to understand how the transition from paper to computer might work. Disappointingly, a new study published today in the Journal of the American Medical Informatics Association finds patient safety issues related to EHRs persist long after the 'go live' date.

Doctors are being forced to pull data out of multiple EMRs -- plus use phones and pagers -- to care for patients. This context switching slows down work and frustrates the goal of electronic health data.

This year's medical student graduating class will be the first group of physicians trained without paper-based medical records. These students understand how electronic health information is supposed to be better than paper, but what will they encounter in reality? Most doctors and other healthcare workers already in the trenches are familiar with less-than-positive scenarios.

Let's say a Mr. Jones is admitted to the intensive care unit with a possible cardiac condition. You spend close to one hour reviewing his medical history in the ER. Concerned with his EKG tracing and abnormal electrolytes, you admit him to the cardiac intensive care unit.

The global e-prescribing market is projected to be valued at $887.8 million in 2019, growing at a compound annual growth rate of 23.5 percent, according to a new report from Transparency Market Research.

The market is witnessing a significant growth led by various government programs to implement e-prescribing systems in order to improve the quality of healthcare and reduce medication errors, the report found. The e-prescribing system is used in various applications, including preparation of a complete medication list, data security checks, complete information of formulary, and patient historical data.

WASHINGTON -- At the 2014 Government Health IT Conference & Exhibition in Washington, D.C., this week, lawmakers, federal officials, health care providers and patient advocates emphasized the potential of health IT to improve the health care system. However, the burden on health care providers and the need for better patient engagement need to be addressed, they said.

Lawmakers Support Health IT, but Push for Some Policy Changes

Rep. Tom Price (R-Ga.), a medical doctor and self-proclaimed "huge advocate for health IT, EHRs and EMRs," said he recognizes the value and potential of big data and health IT.

Rep. Michael Burgess (R-Texas) said that he took longer to embrace the benefits of health IT, noting that his "experience with health IT was not always a good one." However, he cited Hurricane Katrina -- which destroyed many paper medical records -- as a "firsthand example of why electronic health records are important." Burgess explained that many of those displaced by the hurricane came to his home state of Texas to receive care. Shortly thereafter, he visited New Orleans and saw firsthand the state of the city, and many water-sodden paper health records.

Confusing displays, improperly configured software, upgrade glitches and systems failing to speak to one another—those are just a few electronic health record-related events that put patients in danger, according to a new study.

The more complex an EHR system, the more difficult it may be to trace problems, patient safety experts warn. Hospitals planning to add new software or make updates should be strategic about changes and proactively include ways to monitor events.

“Because EHR-related safety concerns have complex socio-technical origins, institutions with longstanding, as well as recent EHR implementations, should build a robust infrastructure to monitor and learn from them,” concluded the report published Friday in the Journal of the American Medical Informatics Association.

Researchers evaluated 100 closed safety investigations reported between August 2009 and May 2013 to the Informatics Patient Safety Office of the Veterans Health Administration. Among the findings, 74 events resulted from unsafe technology, such as system failures, computer glitches, false alarms or “hidden dependencies,” a term for what happens when a change in one part of a system inadvertently leads to key changes in another part. Another 25 events involved unsafe use of technology such as an input error or a misinterpretation of a display.